Kidney-tonifying and Blood-activating Prescription Regulates Wnt/β-catenin Signaling Pathway to Improve Uterine Spiral Artery Remodeling in Mouse Model of Recurrent Miscarriage / 中国实验方剂学杂志

ObjectiveTo observe the effects of the kidney-tonifying and blood-activating prescription on the Wnt/β-catenin signaling pathway and uterine spiral artery remodeling in a mouse model of recurrent miscarriage and to explore its underlying mechanism. MethodA mouse model of normal pregnancy was established by mating CBA/J mice with BALB/c mice. A mouse model of recurrent miscarriage was established by mating CBA/J mice with DBA/2 mice. The modeled mice of recurrent miscarriage were randomized into model， dydrogesterone， and low- and high-dose Chinese medicine groups. The mice in normal pregnancy were used as the control group. Each group consisted of 10 mice， and the drug administration lasted for 14 days. After the treatment， the embryo absorption rate of each group was recorded. Hematoxylin-eosin （HE） staining was employed to observe the pathological morphology of the uterine decidua， and the physiological transformation rate of spiral arteries （SPA） was evaluated. Real-time polymerase chain reaction （Real-time PCR） and Western blot were performed to determine the mRNA and protein levels， respectively， of matrix metalloproteinases （MMP）-2， MMP-9， vascular endothelial growth factor （VEGF）， and Wnt/β-catenin signaling pathway. ResultCompared with the control group， the model group presented increased embryo absorption rate （P<0.05）， decreased physiological transformation rate of uterine SPA （P<0.05）， cellular swelling， degeneration， and disordered arrangement in the uterine decidua tissue， and down-regulated mRNA and protein levels of key factors involved in SPA remodeling （MMP-2， MMP-9， VEGF） and the Wnt/β-catenin signaling pathway （Wnt2， β-catenin， Cyclin D1， c-Myc） （P<0.05）. Compared with the model group， both the low- and high-dose Chinese medicine reduced embryo absorption rate （P<0.05）， increased SPA physiological transformation rate （P<0.05）， improved uterine decidua tissue morphology， and increased decidua vessel count. Furthermore， they up-regulated the mRNA and protein levels of MMP-2， MMP-9， VEGF， and proteins in the Wnt/β-catenin signaling pathway （P<0.05）. ConclusionRecurrent miscarriage is associated with impaired uterine spiral artery remodeling. The kidney-tonifying and blood-activating prescription can promote uterine spiral artery remodeling by activating the Wnt/β-catenin signaling pathway and promoting the expression of VEGF， MMP-2， and MMP-9， thus treating recurrent miscarriage.

miR604A>G gene polymorphism is associated with recurrent pregnancy loss in Turkish women

SUMMARY OBJECTIVE: Recurrent pregnancy loss is considerably a reproductive health problem for couples. Genetic, epigenetic, and environmental factors play an important role in the development of recurrent pregnancy loss. While there are many causes, genetic and epigenetic factors are common. In this study, we aimed to examine the association between miR604 (rs2368393) A>G gene polymorphism and the risk of recurrent miscarriage in the Turkish population. METHODS: The study included 250 participants (i.e., 150 patients and 100 controls). DNA samples were isolated from peripheral blood, and polymerase chain reactions and restriction fragment length polymorphism methodologies were applied. RESULTS: The genotype distribution and allele frequencies of miR604A>G gene showed statistically significant differences between patients and control groups (p=0.002 and p<0.002, respectively). CONCLUSION: As a result of the study, we found that the AA genotype and A allele of the miR604A>G gene were statistically significant for the risk of recurrent pregnancy loss in Turkish women.

Predictive factors and risk analysis of recurrent laryngeal nerve invasion in papillary thyroid carcinoma ≤ 1 cm

ABSTRACT Objective: The recurrent laryngeal nerve (RLN) may be involved by papillary thyroid carcinoma ≤ 1 centimeter (PTC ≤ 1 cm). Current study investigated the predictive factors of RLN invasion in PTC ≤ 1 cm, the risk factors of disease recurrence in RLN invaded cases and the results of surgical management for RLN invasion. Materials and methods: Data of 374 PTC ≤ 1 cm patients were retrospectively collected. We performed univariate and multivariate analysis to identify predictive factors of RLN invasion and risk factors of disease recurrence. The abilities of factors in predicting RLN invasion were evaluated. Surgical outcomes and recurrence free survival (RFS) of patients were analyzed. Results: A total of 28 patients suffered RLN invasion, among which seven had disease recurrence. Preoperative vocal cord palsy (VCP), gross extrathyroidal extension, larger tumor size and tumor on the dorsal side of thyroid were verified as predictive factors of RLN invasion. RLN involved patients had poorer RFS, but better than those who also had upper-aerodigestive tract invasion. Upper-aerodigestive tract invasion, lateral neck lymph nodes metastasis (LNM) and BRAF V600E mutation were independent risk factors of disease recurrence in RLN invaded cases. Tumor shaving showed better RLN function preservation without increasing recurrent risk. Conclusions: Current study confirmed the rarity of RLN invasion in PTC ≤ 1 cm. Various aggressive features were verified as predictive factors of RLN invasion. Tumor shaving showed superiority in preserving nerve function without increasing recurrent risk. Special attentions should be paid for disease recurrence when RLN invasion accompanied by upper-aerodigestive tract invasion, lateral neck LNM or BRAF V600E mutation.

Evaluation of Clinical & Functional Outcomes Bristow Latarjet Procedure in the Management of Recurrent Anterior Shoulder Dislocation

Background: Glenohumeral joint is highly susceptible to dislocation due to its wide range of movements. Recurrent anterior shoulder dislocations are common in young adults. The Bristow Latarjet procedure is one of the effective techniques for the treatment of recurrent anterior shoulder dislocation. This study aimed to assess the clinical and functional outcome of the Bristow Latarjet procedure in the management of recurrent anterior shoulder dislocation. Material & Methods: This prospective interventional study was conducted in the Department of Orthopaedic Surgery, BSMMU, from October 2017 to September 2019. Within this period, a total of 40 cases of recurrent anterior shoulder dislocation that meet inclusion criteria were taken as a sample. Patients were evaluated both pre and postoperatively for functional outcomes according to Rowe’s score for instability. A purposive non-randomized sampling technique was used in this study. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Science (SPSS-25). The results were expressed as frequency, percentage and mean ± SD. Paired Student’s‘t’ test was performed to compare pre and final postoperative follow-up. The level of significance was calculated at a confidence interval of 95% and p-value <0.05. Results: : In this study age of the patient ranged from 18-40 years and the mean age was 28.2±6.3. 29(72.5). Surgery was done within 4-6 months of the first dislocation in 5 patients, within 6-12 months in 21 patients and after 12 months in 14 patients. The mean (±SD) Rowe score for instability was significantly (p<0.001) higher 6 months after the Bristow Latarjet procedure at 91.87(±9.00) in comparison to preoperative periods 52.62(±18.40). Results were excellent in 32(80%), good in 4(10%), fair in 3(7.5%) and poor in 1(2.5%) patients. 36(90%) patients were in the satisfactory group and only 4(10%) in the unsatisfactory group. Only 1(2.5%) patient developed screw migration, 2(5%) patients developed subluxation, and 1(2.5%) patient developed postoperative arthritis. Conclusion: It can be concluded that the Bristow-Latarjet procedure is a very effective and safe procedure with reduced complications, presenting very satisfactory functional results in the treatment of recurrent anterior shoulder dislocation.

COVID-19 vaccination, dengue hepatitis, and recurrent unilateral anterior uveitis

A 36-year-old Asian Indian male presented with redness and pain in his right eye of 1 week duration. He was diagnosed to have right acute anterior uveitis and had a history of being admitted at a local hospital for dengue hepatitis a month earlier. He had been on adalimumab 40 mg three weekly once and oral methotrexate 20 mg/week for human leucocyte antigen (HLA) B27 spondyloarthropathy and recurrent anterior uveitis. Our patient had re-activation of his anterior chamber inflammation on three distinct occasions: first, 3 weeks following recovery from coronavirus disease 2019 (COVID-19), the second after the second dose of COVID-19 vaccination, and the third after recovery from dengue fever-associated hepatitis. We propose molecular mimicry and bystander activation as the postulated mechanisms for the re-activation of his anterior uveitis. In conclusion, patients with auto-immune diseases can have recurrent ocular inflammation following COVID-19 or its vaccination or dengue fever as seen in our patient. The anterior uveitis is usually mild and responds to topical steroids. Additional immuno-suppression may not be needed. Mild ocular inflammation following vaccination should not deter individuals from getting COVID-19 vaccination.

Clinical and paraclinical characteristics in pediatric patients with acute recurrent and chronic pancreatitis: a cohort in Mexico / Características clínicas y paraclínicas en pacientes pediátricos con pancreatitis aguda recurrente y crónica: una cohorte en México

Abstract Background: Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are infrequent clinical entities in pediatric patients, as less than 8% of the literature mentions this population. This study aimed to describe the clinical and paraclinical profile, and the etiology related to patients with ARP and CP attended at a tertiary-level healthcare institute in Mexico. Methods: We conducted a retrospective study from medical records of patients with ARP and CP attended between 2010 and 2020, analyzing the clinical characteristics, imaging studies, and the etiology associated with each patient. Results: We analyzed 25 patients: 17 were diagnosed with ARP, and eight with CP. The main etiology identified was an anatomical alteration of the pancreatic duct (32%); pancreas divisum was the most prevalent condition. In 48% of the population, the etiology was not identified. The group with CP was higher in frequency for calcifications and dilation of the pancreatic duct (p < 0.005) compared to the ARP group. Conclusions: The main etiology for ARP and CP was an anatomical alteration of the pancreatic duct; however, in almost half of the cases, no established cause was identified. Although comparing our results with those offered by large cohorts such as the INSPPIRE group can be complex, we found relevant similarities. Currently, the data obtained from this first descriptive study are the foundation for future research in the field of Mexican pediatric pancreatology.

Resumen Introducción: La pancreatitis aguda recurrente (PAR) y crónica (PC) son entidades poco frecuentes en la edad pediátrica; sin embargo, menos del 8% de la literatura hace referencia a esta población. El objetivo de este estudio fue describir el perfil clínico, paraclínico y etiologías vinculadas en los pacientes con PAR y PC atendidos en una institución de tercer nivel de atención en México. Métodos: Se realizó un estudio retrospectivo de los expedientes de los pacientes con PAR y PC atendidos entre 2010 a 2020, analizando las características clínicas, estudios de imagen y etiologías asociadas en cada uno de los pacientes. Resultados: Se analizaron 25 pacientes, 17 con diagnóstico de PAR y ocho con PC. La principal etiología identificada correspondió a las alteraciones anatómicas del conducto pancreático (32%); el páncreas divisum fue la entidad más prevalente. En el 48% de la población no se pudo identificar una etiología. El grupo con PC presentó mayor frecuencia de calcificaciones y dilatación ductal pancreática (p < 0.005) en comparación al grupo de PAR. Conclusiones: La principal etiología de PAR y PC identificada en nuestro estudio corresponde a las alteraciones anatómicas del conducto pancreático; sin embargo, en casi la mitad de los casos, no se tiene una causa establecida. Aunque es complicado comparar nuestros resultados con los ofrecidos por las grandes cohortes del grupo INSPPIRE, sí encontramos similitudes relevantes. Los datos obtenidos en este primer estudio descriptivo son la base para futuras investigaciones en el ámbito de la pancreatología pediátrica mexicana.

Tumor risk markers in recurrent respiratory papillomatosis

Abstract Objectives: This study aims to investigate the pattern of immunoexpression of proteins p16, p53 and Ki-67 in RRP, as well as to evaluate its influence on the number of surgeries that patients have undergone to date and to analyze the benefit of immunohistochemistry in this disease. Methods: Clinical-demographic data and tumor samples were obtained from 33 patients with RRP. The expression of proteins p16, p53 and Ki-67 was analyzed by immunohistochemical method. Results: Most patients had already undergone more than one surgery. The p16 marker was negative in 24.2% of the cases, with little positivity in 27.3% of the cases, moderate in 36.4% and intense in 12.1%. The p53 marker was positive in all cases, with little immunoexpression in 39.4% of cases, moderate in 36.4% and intense in 24.2%. The Ki-67 marker showed nuclear positivity in all lesions, although in varying degrees, with a mean proliferative index ±SD (standard deviation) of 51.7±26. Conclusions: The papillomatous lesions had varying degrees of immunoexpression of proteins p16, p53 and Ki-67, but no specific immunohistochemical pattern was observed. It was found, with statistical difference, that the number of surgeries was higher in cases with greater intensity of p53 expression, without correlation with the other markers. The benefit of immunohistochemistry in recurrent respiratory papillomatosis may lie in the prognostic assessment. However, further studies are needed to evaluate the use of this technique for this purpose. Level of evidence:: 4.

Recurrent dermatofibrosarcoma protuberans of the breast: A case report and review of literature

Dermatofibrosarcoma protuberans (DFSP) is a rare and low-grade sarcoma of fibroblast origin with a tendency to invade and recur locally. The most common sites of origin of DFSP are the head, neck, and extremities. However, DFSP breast has also been reported. It infiltrates surrounding subcutaneous tissue and fascia, with an incidence of <2% for lung metastases. Surgery being the main modality of the treatment, literature has shown that radiation therapy also plays an important role to improve local control in case of recurrent tumors. In this article, we will be discussing one such rare case of DFSP in a recurrent setting and the role of radiation therapy.

El niño plateado: Síndrome de Chediak-Higashi / The Silver Child: Chediak-Higashi Syndrome

El Síndrome de Chediak-Higashi (SCH) es una patología de herencia autosómica recesiva debido principalmente a mutaciones del gen regulador del tráfico lisosómico (LYST), causando grados dermatológicamente diferentes de albinismo óculocutáneo, infecciones recurrentes, disfunción fagocítica primaria, en el desarrollo y proliferación de todas las líneas celulares. Se presenta caso de preescolar masculino de 2 años de edad, ingresado por aumento de volumen bilateral en región cervical y fiebre, en malas condiciones generales, con áreas de hiperpigmentación en piel, cabello y cejas de coloración grisácea, adenopatías generalizadas y visceromegalias; leucocitosis con linfocitosis y neutropenia, anemia, trombocitopenia, hipoalbuminemia, hipertrigliceridemia e hiperferritinemia; en vista de la infrecuente coexistencia de dichas características con albinismo óculocutáneo; es evaluado por hematología y dermatología evidenciándose inclusiones citoplasmáticas y melanosomas gigantes, respectivamente, compatibles con SCH, confirmándose diagnóstico. El conocimiento del SCH es importante para la oportuna sospecha clínica-diagnóstica e inicio de protocolos terapéuticos en consenso, que garanticen un manejo eficaz para su sobrevida(AU)

Chediak-Higashi syndrome (SCH) is an auto somal recessive in herited pathology mainly due to mutations ofthe LYST gene, causing dermatologically different degrees of oculocutaneous albinism, recurrent infections, primary phagocytic dysfunction, in the development and proliferation of all cell lines. We present a case of a 2-year-old male preschool, admitted due to bilateral volume increase in thecervical region and fever, in poor general conditions, with areas of hyperpigmentation in skin, hair and eyebrows of grayish coloration, generalized lymphadenopathy and visceromegaly; leukocytosis with lymphocytosis and neutropenia, anemia, thrombocytopenia, hypoalbuminemia, hypertriglyceridemia,and hyperferritinemia; in view of the infrequent coexistence of these characteristics with oculocutaneous albinism; it isevaluated by hematology and dermatology, showing cytoplasmicinclusions and giant melanosomes, respectively, compatiblewith SCH, confirming the diagnosis. Knowledge of SCH is important for timely clinical-diagnostic suspicion and initiation of consensus therapeutic protocols that guarantee effective management for survival(AU)

CONTEXTUAL LEARNING APPROACH FOR SYNDROME DISEASE NAMED ENTITY RECOGNITION

The groundwork for extracting a significant amount of biomedical information from unstructured texts into structured formats is the difficult research area of biological entity recognition from medical documents. The existing work implemented the named entity recognition for diseases using the sequence labelling framework. The performance of this strategy, however, is not always adequate, and it frequently cannot fully exploit the semantic information in the dataset. The Syndrome Diseases Named Entity problem is presented in this work as a sequence labelling with multi-context learning. By using well-designed text/queries, this formulation may incorporate more previous information and to decode it using decoding techniques such conditional random fields (CRF). We performed experiments on three biomedical datasets, and the outcomes show how effective our methodology is on the BC5CDR-Disease, JNLPBA and NCBI-Disease, compared with other techniques our methodology performs with accuracy levels of 96.70%,98.65 and 96.72% respectively.

Rehabilitación del nervio recurrente laríngeo postiroidectomía / Recurrent laryngeal nerve rehabilitation after thyroidectomy

El carcinoma papilar tiroideo es el tipo de cáncer más común de esta glándula, y su tratamiento de elección es la tiroidectomía. Entre las complicaciones asociadas resalta la parálisis de las cuerdas vocales, la cual ocurre por una lesión directa del nervio laríngeo recurrente durante la cirugía. Se presenta una paciente de 22 años de edad con este diagnóstico, a la cual se le realizó una tiroidectomía total; en el postoperatorio inmediato la paciente comenzó con estridor laríngeo intenso que requirió una traqueotomía de urgencia. En el examen físico se constató una parálisis bilateral de las cuerdas vocales y se decidió comenzar un tratamiento de rehabilitación del nervio recurrente laríngeo con laserterapia y HIVAMAT-200 como modalidades combinadas. Los resultados alcanzados con la fisioterapia fueron satisfactorios y la paciente se reintegró rápidamente a su ámbito familiar, escolar y social.

Papillary thyroid carcinoma is the most common type of cancer of this gland, and its treatment of choice is thyroidectomy. Vocal cord paralysis stands out among the associated complications, in which a direct injury to the recurrent laryngeal nerve occurs during surgery. We present a 22-year-old female patient with this diagnosis, who underwent a total thyroidectomy; in the immediate postoperative period the patient began with intense laryngeal stridor requiring an emergency tracheotomy. Physical examination revealed bilateral vocal cord paralysis and it was decided to begin rehabilitation treatment of the recurrent laryngeal nerve with laser therapy and HIVAMAT-200 as combined modalities. The results achieved with physiotherapy were satisfactory and the patient was quickly reintegrated into her family, school and social environment.

Estudio aleatorizado, doble ciego, sobre la eficacia del tratamiento homeopático en niños con amigdalitis recurrente / Randomized, double-blind study on the efficacy of homeopathic treatment in children with recurrent tonsillitis

La eficacia y seguridad del tratamiento homeopático fueron investigadas en niños con amigdalitis recurrente para la que se indicaba cirugía. Métodos: Estudio clínico prospectivo, aleatorizado, doble ciego, que incluyó 40 niños de entre 3 y 7 años de edad; 20 niños fueron tratados con medicación homeopática y otros 20 niños, con placebo. El seguimiento fue de 4 meses por niño. La evaluación de los resultados fue clínica mediante un cuestionario estándar y examen clínico el primer y último día de tratamiento. La amigdalitis recurrente se definió como ocurrencia de 5 a 7 episodios de amigdalitis bacteriana aguda al año. Resultados: Del grupo de 18 niños que completó el tratamiento homeopático, 14 no presentó episodio alguno de amigdalitis bacteriana aguda; del grupo de 15 niños que recibió placebo, 5 pacientes no presentaron amigdalitis. Esta diferencia fue estadísticamente significativa (p = 0,015). Ninguno de los pacientes presentó efectos secundarios. Conclusiones: El tratamiento homeopático fue efectivo en niños con amigdalitis recurrente, en comparación con el placebo; a 14 niños (78%) ya no se les indicó cirugía. El tratamiento homeopático no se asoció con eventos adversos.

The efficacy and safety of homeopathic treatment was investigated on children with recurrent tonsillitis justifying surgery. Methods: Prospective, randomized,double-blind clinical trial that included 40 children between ages of 3 to 7 years old;20 children were treated with homeopathic medication and 20 children with placebo. Follow up was 4 months per child. Assessment of results was clinical by means of a standard questionnaire and clinical examination on the first and last day of treatment.Recurrent tonsillitis was defined as 5 to 7 episodes of bacterial acute tonsillitis per year. Results: From the group of 18 children who completed homeopathic treatment, 14 did not present any episode of acute bacterial tonsillitis; from the group of 15 children whoreceived placebo 5 patients did not present tonsillitis; this difference was statistically significant (p= 0,015). None of the patient exhibited side effects. Conclusions: Homeopathic treatment was effective in children with recurrent tonsillitis compared to placebo, 14 children (78%) were no longer indicated surgery. Homeopathic treatment was not associated with adverse events.

Thymoma: A rare presentation as recurrent pericardial effusion

Recurrent pericardial effusion is always complicated for the primary care physician to diagnose, and it often goes undiagnosed. Thymoma is rare cancer, but it is the most common tumor in the anterior mediastinum. It can present in a variety of ways; it can be asymptomatic for an extended period of time and only rarely as pericardial effusion. A 68‑year‑old male presented to us with two episodes of pericardial effusion in the previous 2 years and was later diagnosed with thymoma.

Sibilancia recurrente en pediatría

Introducción: los episodios de obstrucción bronquial a temprana edad constituyen un problema frecuente en pediatría. Se realizó un estudio descriptivo, longitudinal, retrospectivo. Objetivo: caracterizar el comportamiento de la sibilancia recurrente en los niños menores de 5 años pertenecientes al municipio Bayamo, del Hospital Provincial Pediátrico Docente "General Milanés "en el año 2019. Métodos: la muestra fue de 63 pacientes y se estudiaron las variables edad, sexo, lactancia materna, ingresos previos, procedencia, género de vida y posibles factores de riesgo. El análisis estadístico se realizó a través de las estimaciones de las frecuencias absolutas y relativas. Resultados: predominaron los niños de 1 a 5 años con 52 casos (82.6%) y el sexo masculino, 29 de ellos pertenecieron a este grupo etáreo ( 80.6%); los ingresos previos de menos de 3 días en 37 casos (66.1%) y 56 casos no recibieron lactancia materna exclusiva, 37 de ellos representó el 66.1%; 44 casos tuvieron un género de vida malo ( 69.8%) y de los 43 casos que procedían de la zona urbana 28 pertenecían a ese género de vida(65.1%); los antecedentes patológicos familiares de alergia o asma y la atopia fueron los más significativos con 63 y 52 casos(100 y 82.5%) respectivamente. Conclusiones: se comprobó que la edad de 1 a 5 años, el sexo masculino, los ingresos de menos de tres días, sin lactancia materna , el género de vida malo, la procedencia urbana fueron los que predominaron en el estudio, así como los antecedentes patológicos familiares y la atopia como factores de riesgo que exacerbaron la enfermedad.

Introduction: episodes of bronchial obstruction at an early age are a frequent problem in pediatrics. A descriptive, longitudinal, retrospective study was conducted. Objective: to characterize the behavior of recurrent wheezing in children under 5 years of age belonging to the Bayamo municipality, of the "General Milanés" Teaching Pediatric Provincial Hospital in 2019. Methods: the sample consisted of 63 patients and the variables age, sex, breastfeeding, previous income, origin, gender of life and possible risk factors were studied. Statistical analysis was performed through estimates of absolute and relative frequencies. Results: there was a predominance of children aged 1 to 5 years with 52 cases (82.6%) and males, 29 of them belonged to this age group (80.6%); previous admissions of less than 3 days in 37 cases (66.1%) and 56 cases did not receive exclusive breastfeeding, 37 of them accounted for 66.1%; 44 cases had a bad lifestyle (69.8%) and of the 43 cases that came from the urban area, 28 belonged to that kind of life (65.1%); Family pathological history of allergy or asthma and atopy were the most significant wit. Conclusions: it was found that age from 1 to 5 years, male sex, income of less than three days, without breastfeeding, poor lifestyle, urban origin were those that predominated in the study, as well as family pathological history and atopy as risk factors that exacerbated the disease.

Introdução: episódios de obstrução brônquica em idade precoce são um problema frequente em pediatria. Trata-se de um estudo descritivo, longitudinal e retrospectivo. Objetivo: caracterizar o comportamento da sibilância recorrente em crianças menores de 5 anos pertencentes ao município de Bayamo, do Hospital Provincial Pediátrico Universitário "General Milanés", em 2019. Métodos: a amostra foi composta por 63 pacientes e estudadas as variáveis idade, sexo, aleitamento materno, renda prévia, procedência, sexo de vida e possíveis fatores de risco. A análise estatística foi realizada por meio de estimativas de frequências absolutas e relativas. Resultados: houve predomínio de crianças de 1 a 5 anos com 52 casos (82,6%) e do sexo masculino, sendo que 29 deles pertenciam a essa faixa etária (80,6%); internações anteriores inferiores a 3 dias em 37 casos (66,1%) e 56 casos não receberam aleitamento materno exclusivo, sendo que 37 deles corresponderam a 66,1%; 44 casos tinham estilo de vida ruim (69,8%) e dos 43 casos provenientes da zona urbana, 28 pertenciam a esse tipo de vida (65,1%); História anatomopatológica familiar de alergia ou asma e atopia foram as mais significativas, com 63 e 52 casos (100 e 82,5%), respectivamente. Conclusões: verificou-se que idade de 1 a 5 anos, sexo masculino, renda inferior a três dias, ausência de aleitamento materno, estilo de vida ruim, origem urbana foram os que predominaram no estudo, assim como história patológica familiar e atopia como fatores de risco que exacerbaram a doença.

Safety and efficacy of short-term dual antiplatelet therapy combined with intensive rosuvastatin in acute ischemic stroke

Abstract Objective: To investigate the safety and efficacy of short-term (7-day) Dual Antiplatelet Therapy (DAPT) with intensive rosuvastatin in Acute Ischemic Stroke (AIS). Methods: In this study, patients with AIS in the emergency department of the hospital from October 2016 to December 2019 were registered and divided into the control group (Single Antiplatelet Therapy [SAPT] + rosuvastatin) and the study group (7-day DAPT + intensive rosuvastatin) according to the therapy regimens. The generalized linear model was used to compare the National Institute of Health Stroke Scale (NIHSS) scores between the two groups during the 21-day treatment. A Cox regression model was used to compare recurrent ischemic stroke, bleeding events, Statin-Induced Liver Injury (SILI), and Statin-Associated Myopathy (SAM) between the two groups during the 90-day follow-up. Results: Comparison of NIHSS scores after 21-day treatment: NIHSS scores in the study group decreased significantly, 0.273-times as much as that in the control group (Odds Ratio [OR] 0.273; 95% Confidence Interval [95% CI] 0.208-0.359; p < 0.001). Comparison of recurrent ischemic stroke during the 90-day follow-up: The therapy of the study group reduced the risk of recurrent stroke by 65% (7.76% vs. 22.82%, Hazard Ratio [HR] 0.350; 95% CI 0.167-0.730; p = 0.005). Comparison of bleeding events: There was no statistical difference between the two groups (7.79% vs. 6.71%, HR = 1.076; 95% CI 0.424-2.732; p = 0.878). No cases of SILI and SAM were found. Conclusions: Short-term DAPT with intensive rosuvastatin effectively relieved the clinical symptoms and significantly reduced the recurrent stroke for patients with mild-to-moderate AIS within 90 days, without increasing bleeding events, SILI and SAM.

Manifestaciones bucales de la enfermedad de Crohn y colitis ulcerosa en adultos mayores / Oral manifestations of Crohn´s disease and ulcerative colitis in of elderly adults

Objetivo: identificar las manifestaciones clínicas bucales de la enfermedad de Crohn y colitis ulcerosa en pacientes adultos mayores. Métodos: se efectuó un estudio descriptivo transversal con un universo de 50 adultos mayores, previamente diagnosticados por los especialistas gastroenterólogos, y prescritos con enfermedad de Crohn y colitis ulcerosa. Estos, confirmados por los hallazgos clínicos, histopatológicos y endoscópicos, remitidos a consulta estomatológica del Policlínico de Especialidades del Hospital Clinicoquirúrgico Universitario "Saturnino Lora Torres" de Santiago de Cuba, entre marzo de 2019 y marzo de 2020, practicándose el examen intrabucal, descripción de las lesiones bucales y su diagnóstico clínico. Para la recolección del dato primario se confeccionó un modelo con las variables: edad, sexo, enfermedad inflamatoria intestinal, localización anatómica, signos y síntomas clínicos orales en ambas patologías. Se creó una base de datos en SPSS versión 22.0 en Windows para el procesamiento y análisis de la información, usándose la técnica estadística descriptiva y agrupándose los datos en frecuencias absolutas y relativas. Resultados: en la serie resaltaron las personas de sexo femenino y el grupo de edades de 60 a 74 años, la pioestomatitis vegetante fue el signo bucal específico más común y la úlcera aftosa recurrente la lesión inespecífica de mayor predominio en ambas patologías. El dolor, el síntoma clínico de mayor afectación y el dorso de lengua el sitio de mayor predilección para su instalación. Conclusiones: las expresiones clínicas bucales más relevantes en pacientes adultos mayores con enfermedad de Crohn y colitis ulcerosa fueron la pioestomatitis vegetante y la úlcera aftosa recurrente.

Objective: Identify the oral clinical manifestations of Crohn´s disease and ulcerative colitis in elderly adults' patients. Methods: a cross-sectional descriptive study was carried out with a universe of 50 older adults previously diagnosed by gastroenterologist specialists, prescribing the presence of Crohn's disease and ulcerative colitis, confirmed by clinical, histopathologica and endoscopic findings, referred to the stomatological consultation of the Specialities Policlinic of the "Saturnino Lora Torres" University Clinical Surgical Hospital of Santiago de Cuba, from March 2019 to the same month of 2020, performing intraoral examination, description of oral lesions and their clinical diagnosis. For the collection of the primary data, a model was made with the variables: age, sex, inflammatory bowel disease, anatomical location, oral clinical signs and symptoms in both pathologies. A database was created in SPSS version 22.0 in Windows for the processing and analysis of the information, using the descriptive statistical technique and grouping the data in absolute and relative frequencies. Results: in the casuistry, females and the age group of 60 to 74 years prevailed, vegetative pyostomatitis was the most common specific oral sign and recurrent aphthous ulcer was the most prevalent non-specific lesion in both pathologies, pain being the most affecting clinical symptom and the back of the tongue is the most preferred site for its installation. Conclusions: the most relevant oral clinical expressions in elderly patients adults with Crohn´s disease and ulcerative colitis were pyostomatitis vegetative and recurrent aphthous ulcer.

Characteristics of lymph node metastasis of right recurrent laryngeal nerve in thoracic esophageal squamous cell carcinoma / 中华肿瘤杂志

Objective: To understand the characteristics and influencing factors of lymph node metastasis of the right recurrent laryngeal nerve in thoracic esophageal squamous cell carcinoma (ESCC), and to explore the reasonable range of lymph node dissection and the value of right recurrent laryngeal nerve lymph node dissection. Methods: The clinicopathological data with thoracic ESCC were retrospectively analyzed, and the characteristics of lymph node metastasis along the right recurrent laryngeal nerve and its influencing factors were explored. Results: Eighty out of 516 patients had lymph node metastasis along the right recurrent laryngeal nerve, the metastasis rate was 15.5%. Among 80 patients with lymph node metastasis along the right recurrent laryngeal nerve, 25 cases had isolated metastasis to the right recurrent laryngeal nerve lymph node but no other lymph nodes. The incidence of isolated metastasis to the recurrent laryngeal nerve lymph node was 4.8% (25/516). A total of 1 127 lymph nodes along the right recurrent laryngeal nerve were dissected, 115 lymph nodes had metastasis, and the degree of lymph node metastasis was 10.2%. T stage, degree of tumor differentiation and tumor location were associated with right paraglottic nerve lymph node metastasis (all P<0.05). The lymph node metastasis rate along the right recurrent laryngeal in patients with upper thoracic squamous cell carcinoma (23.4%, 26/111) was higher than that of patients with middle (13.5%, 40/296) and lower (12.8%, 14/109) thoracic squamous cell carcinoma (P=0.033). In patients with poorly differentiated ESCC (20.6%, 37/180) the metastasis rate was higher than that of patients with moderately (14.6%, 39/267) and well-differentiated (5.8%, 4/69; P<0.05). The lymph node metastasis rate of patients with stage T4 (27.3%, 3/11) was higher than that of patients with stage T1 (9.6%, 19/198), T2 (19.0%, 16/84) and T3 (18.8%, 42/1 223; P<0.05). Multivariate regression analysis showed that tumor location (OR=0.61, 95% CI: 0.41-0.90, P=0.013), invasion depth (OR=1.46, 95% CI: 1.11-1.92, P=0.007), and differentiation degree (OR=1.67, 95% CI: 1.13-2.49, P=0.011) were independent risk factors for lymph node metastasis along right recurrent laryngeal nerve of ESCC. Conclusions: The lymph node along the right recurrent laryngeal nerve has a higher rate of metastasis and should be routinely dissected in patients with ESCC. Tumor location, tumor invasion depth, and differentiation degree are risk factors for lymph node metastasis along right recurrent laryngeal nerve in patients with ESCC.

A case of recurrent Miller-Fisher syndrome with multiple anti-ganglioside antibodies / 中国综合临床

Guillain-Barré syndrome (GBS) defines a kind of Immune-mediated acute inflammatory peripheral neuropathy. Miller-Fisher Syndrome (MFS) is a special variant of GBS, with mostly one-way course and rare clinical recurrence. Only a few recurrent cases have been reported in China. Here we report a case of a young male patient with double vision and progressive aggravation of limb numbness, acute onset, with symptoms of upper respiratory tract infection before onset, accompanied by pupil abnormalities and autonomic nervous dysfunction, who was was admitted to our hospital for similar symptoms 3 years ago and was improved by immunotherapy. The patient had a triad of “ataxia, areflexia and ophthalmoplegia”. Cerebrospinal fluid showed protein-cell separation. Serum anti-Sulfatides antibody IgM, anti-GT1a antibody IgG, anti-GQ1b antibody IgG and anti-GM3 IgM were positive. Recurrent MFS was diagnosed and the symptoms improved after immunotherapy. This case suggests that MFS is clinically heterogeneous, a few patients can present with relapse and generally have a better prognosis with immunotherapy. Pre-existing infection and anti-GQ1b antibody production may be predisposing factors for MFS recurrence.

Clinical features and risk factors of recurrent acute pancreatitis / 中华胰腺病杂志

Objective:To explore the clinical characteristics and to analyze the risk factors of recurrent acute pancreatitis (RAP).Methods:The clinical data of 3 022 patients with AP from AP database of the Affiliated Hospital of Southwest Medical University between January 2013 and December 2019 were retrospectively analyzed. According to with or without AP relapse and RAP diagnostic criteria, the patients were divided into initial group ( n=2 187) and recurrent group ( n=835). General characteristics, clinical data, and prognostic indicators were compared between the two groups. Multivariate logistic regression analysis was used to explore the risk factors of RAP. Results:The proportion of men, previous biliary disease, hyperlipidemia, diabetes mellitus and previous gallbladder or biliary surgery in recurrent group were significantly higher, while the mean age was significantly lower than that of the initial group. The main causes in the initial group successively were biliary disorders, hyperlipidemia and alcohol, while in the recurrent group were hyperlipidemia, biliary disorders and alcohol. The etiology of hyperlipidemia was significantly higher in the recurrent group than in initial group. The incidence of MAP and regional portal hypertension was significantly higher in the recurrent group, while the incidence of SAP and acute respiratory distress syndrome were significantly lower than those in the initial group, and all the differences were statistically significant(All P value <0.001). The results of the correlation analysis showed that there was no correlation between the severity of RAP and the number of recurrence, and the risk of SAP in RAP did not decrease with the increasing number of recurrence. The results of the multivariate logistic regression analysis showed that previous biliary disorders ( OR=1.303, 95% CI 1.032-1.645, P=0.026), previous history of hyperlipidemia ( OR=2.631, 95% CI 1.580-4.379, P<0.001), and the etiology of hyperlipidemia ( OR=1.773, 95% CI 1.465-2.145, P<0.001) were independent risk factors for RAP. Conclusions:RAP may often occur in middle-aged men and hyperlipidemia is the main cause of RAP, previous history of hyperlipidemia and biliary disease are risk factors for RAP.